In policy talk, the President’s Emergency Plan For AIDS Relief move from directly supporting AIDS-fighting efforts with money and staff in countries that need help, is called a “transition to country ownership.” That, in policy talk, is what must happen for work to achieve an AIDS-free generation to be “sustainable.”

A report just released by Health Global Access Project, though, says that haste to make that transition in South Africa is endangering the gains made against HIV in the country with the world’s largest epidemic, and the first country slated for the move.

According to The Politics of Transition & the Economics of HIV, AIDS & PEPFAR in South Africa by Matthew Kavanagh, and an accompanying article by him in the Journal of Acquired Immune Deficiency Syndromes, the speed of the move to withdraw human resources and funding has disrupted treatment of hundreds of thousands of people living with HIV. The report and article add detail, data and substance to accounts we heard when the Center for Global Health Policy visited Durban with Congressional staffers in August. In fact the *photo from the inside cover of a sign in a Durban clinic waiting room warning of long waits because of “terrible staff shortage” was taken on our trip, where a single overwhelmed nurse could not take advantage of the “technical support” (training) PEPFAR offers, without abandoning a packed waiting room filled with patients.

The report and article go far beyond the complaints and frustrations of clinic staff and patients, citing the history of South Africa’s challenges (which include the refusal by President Thabo Mbeki to acknowledge the HIV epidemic), the successes joint PEPFAR and South African government efforts have brought since, and studies showing the trajectory of the epidemic, as well as trends of patients lost to care. Most disturbingly, the report shows that while PEPFAR’s “Partnership Implementation Plan” pledged that HIV patients “should not be detrimentally affected by the transition of services,” no plan was in place to track patients whose care was moved from PEPFAR-supported clinics to government facilities. Instead, an NIH-funded study carried out by physician researcher Ingrid Bassett and others, and cited by Kavanagh, found that at least 19 percent of patients receiving antiretroviral treatment through a PEPFAR-supported clinic did not appear for the first visit at the public clinic they were transferred to. Problems beyond the parameters of that study, including for patients needing to travel further, with fewer resources, for patients encountering obstacles at public sector clinics on or after their first visit, and for patients not yet receiving antiretroviral medicine, likely mean even greater losses to care and followup occurred, Kavanagh says.

The report’s eight concrete recommendations specific to the South Africa “transition” include that PEPFAR launch an effort to track those patients, correcting the failure to do so previously — which Kavanagh calls “both an ethical lapse and an enormous missed public health opportunity” — and supplying information to help shape a more appropriate transfer of responsibility. The report also follows with global recommendations, pointing out, as does the JAIDS article, that what happens in South Africa will affect the future of AIDS-fighting efforts around the world.

*The report and article also cite Science Speaks as a reference, and include Center staff in acknowledgements for assistance.